Assignment Task:
You are a consultant who has been asked by the chief compliance officer of a multi-facility health system to assist in evaluating the organization's current enterprise-wide coding compliance plan for facility coding. The system has undergone many changes in recent years, including acquisitions of hospitals and implementation of a clinical documentation integrity program.
1. Who would you need to involve in the evaluation process and why?
2. What resources would you recommend investigating and why?
3. What elements would you recommend to the chief compliance officer to be included in an overall compliance plan and in a more specific coding compliance plan?
4. Describe the data management life cycle for diagnosis codes supporting inpatient DRG reimbursement.
5. Explain the MS-DRG reimbursement method and describe the benefits to the organization for generating a case mix index report based on MS-DRGs.
6. Explain the impact of performing a concurrent and retrospective analysis of the record in determining the integrity of documentation. Want Online Tutoring?
7. Justify reasons for issuing queries to the provider for clarification of documentation; provide an example. When is unacceptable to query the provider for clarification? Provide an example to support your rationale.